Pediatric Anesthesia最新文献

{"title":"PREP-STOP-INFUSE, A Simplified Two-Operator Check for Total Intravenous Pediatric Anesthesia.","authors":"Alexander Gibson, Madeleine Lawrence, Alok Chauhan, Katie Smith, Benjamin J Blaise","doi":"10.1002/pan.70235","DOIUrl":"10.1002/pan.70235","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1162-1164"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148150491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plasma Lidocaine Concentrations During Intravenous Lidocaine Infusion Therapy in the Pediatric Population-A Scoping Review.","authors":"McKenna Postles, Amanda Barton, Nicholas West, Gillian Lauder","doi":"10.1002/pan.70234","DOIUrl":"10.1002/pan.70234","url":null,"abstract":"<p><strong>Background: </strong>Intravenous lidocaine therapy (IVLT) is often used in perioperative multimodal analgesia due to its analgesic, anti-hyperalgesic, and anti-inflammatory effects. In adults, IVLT doses of 1-2 mg/kg/h produce plasma concentrations of 1-2 μg/mL, within the presumed therapeutic range of 1-5 μg/mL. The dose range, expected plasma concentrations, and presumed therapeutic range are not well defined in children. We aimed to review available pharmacokinetic data in pediatric patients receiving IVLT.</p><p><strong>Methods: </strong>We searched MEDLINE, EMBASE, and CINAHL databases for studies reporting pharmacokinetic data for IVLT in healthy 1-18-year-olds, with plasma lidocaine or metabolite levels collected post-infusion, excluding studies involving non-therapeutic infusions or children with comorbidities affecting lidocaine metabolism. Bias was assessed using validated tools. We conducted narrative data synthesis due to reporting variability and summarized plasma lidocaine and/or metabolite levels and the incidence of reported adverse events.</p><p><strong>Results: </strong>Four studies comprising 174 children were included. A study (n = 22) using a 1.5 mg/kg bolus over 30 min followed by a 1 mg/kg/h infusion for 6 h post-surgery achieved highest mean drug concentrations of 2.82 ± 0.65 μg/mL immediately following surgery. Another study (n = 46) utilized a 1.5 mg/kg bolus over 5 min followed by a 2 mg/kg/h infusion and achieved peak concentrations of 4 to < 5 μg/mL. Two studies (n = 106) utilized a 1.5 mg/kg bolus and 1.5 mg/kg/h infusion until transfer to the post-operative anesthesia care unit or six hours post-operatively achieved concentrations that were detectable and < 5 μg/mL. The only adverse event reported was a single participant who experienced transient sensory disturbances.</p><p><strong>Conclusion: </strong>Existing pharmacokinetic data for pediatric IVLT is extremely limited. Reported plasma concentrations were detectable and lower than presumed toxic levels with one reported adverse event. Large-scale, multicenter research is needed to determine optimal pediatric dosing, elucidate dose response curves, and ensure safe and effective use of IVLT in the pediatric population.</p><p><strong>Trial registration: </strong>Prospective Register of Systematic Reviews (PROSPERO): CRD42025636554.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1041-1051"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148157127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Designing a Web-Based Case Repository for Values Education in Early Clinical Exposure: A Conceptual Framework and Development Blueprint.","authors":"Xue Zhang, Xu Yan, Shiyong Li, Xing Li, Ailin Luo, Yilin Zhao","doi":"10.1002/pan.70228","DOIUrl":"10.1002/pan.70228","url":null,"abstract":"<p><strong>Background: </strong>As medical education shifts toward holistic competence, integrating values-based education-including ethical reasoning, professionalism, and humanistic values-into early clinical exposure (ECE) clerkships has become essential. However, scalable and effective tools to embed these components into foundational clinical training remain limited. This paper addresses the need for a structured, technology-enhanced approach to values-based learning in early clinical settings.</p><p><strong>Methods: </strong>The authors synthesized principles from instructional design, clinical pedagogy, and educational technology to develop a conceptual and technological framework for web-based case repositories. The methodology includes a systematic architecture comprising needs analysis, multidisciplinary case authoring, technical infrastructure design, and alignment with blended learning curricula. Application strategies for authentic ECE contexts-such as facilitation techniques, learner engagement, and competency assessment-were also analyzed, alongside critical examination of implementation challenges.</p><p><strong>Results: </strong>The proposed framework yields a scalable, immersive digital repository that supports values-based education through realistic, ethically nuanced cases. Key components include a user-centered technical platform, collaborative case authoring workflows, integration pathways with existing ECE-blended learning models, and assessment tools for values-related competencies. The analysis identifies technological barriers, faculty development needs, and evaluation complexities as major implementation challenges, while suggesting future directions such as AI-driven personalized learning and interoperable resource-sharing standards.</p><p><strong>Conclusions: </strong>This conceptual framework provides a comprehensive foundation for developing web-based case repositories that cultivate ethically grounded, reflective practitioners from the outset of clinical training. Although empirical evidence in this specific area is nascent, the proposed model offers actionable guidance for educators and technologists. Future empirical research is needed to validate the framework's effectiveness in real-world ECE contexts.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1023-1028"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147983009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Codeine Toxicity via Breast Milk.","authors":"Michael Rieder","doi":"10.1002/pan.70238","DOIUrl":"10.1002/pan.70238","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1165-1166"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148176416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Anemia and Perioperative Outcomes in Children: Prevalence, Risk Factors, and Associations in an Australian Cohort.","authors":"Matthew Hart, Alexandra Batinic, Justin Skowno","doi":"10.1002/pan.70236","DOIUrl":"10.1002/pan.70236","url":null,"abstract":"<p><strong>Aims: </strong>Preoperative anemia is a potentially modifiable risk factor in children undergoing surgery, but contemporary data describing its prevalence and associated outcomes in high-income settings are limited. We aimed to determine the prevalence of anemia in a pediatric major-surgery surgical cohort, identify associated demographic and clinical factors, and examine relationships with perioperative outcomes.</p><p><strong>Methods: </strong>We conducted a retrospective observational study of children undergoing major surgery at an Australian tertiary children's hospital. Patients with a hemoglobin measurement within 3 months prior to surgery were included. Anemia was defined according to the World Health Organization 2024 thresholds. Demographic variables, comorbidities, surgical characteristics, transfusion, and postoperative outcomes were extracted. Logistic regression was used to evaluate independent associations between preoperative anemia, red cell transfusion, and postoperative infection.</p><p><strong>Results: </strong>Of 786 eligible patients, 582 (74%) were included. Anemia was present in 123 children (21.1%, 95% CI 18.0-24.6). Anemia was more common in females, higher ASA classification, emergency surgery, and those with chronic comorbidities. In multivariable analyses, anemia was independently associated with red cell transfusion (aOR 2.77, 95% CI 1.74-4.41), and with postoperative infection (aOR 1.89, 95% CI 1.15-3.09). Other postoperative outcomes were not significantly associated with preoperative anemia. Anemia remained common in elective surgical patients, a group in whom preoperative screening and optimization are feasible.</p><p><strong>Conclusion: </strong>Preoperative anemia affects one in five children undergoing major surgery in this Australian cohort and is independently associated with red cell transfusion and postoperative infection. These findings support further evaluation of strategies to identify and manage preoperative anemia in pediatric surgical patients. The observed prevalence and outcome associations in this cohort should be interpreted in the context of missing preoperative hemoglobin data, which may bias estimates toward higher risk patients.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1108-1116"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148239865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Preoperative Inflammatory Markers With Preoperative Anxiety and Emergence Agitation in Children.","authors":"Nezahat Merve Ata Soylu, Zehra Hatipoglu, Ersel Gulec, Mediha Turktan, Nurefsan Sadıkoglu, Yusuf Kemal Arslan, Dilek Ozcengiz","doi":"10.1002/pan.70246","DOIUrl":"10.1002/pan.70246","url":null,"abstract":"<p><strong>Introduction: </strong>Emergence agitation (EA) is a postoperative neurobehavioral complication characterized by a transient disturbance in cognition and perception following anesthesia. Neuroinflammation is thought to play a central role in its pathophysiology. Preoperative anxiety is the \"acute preoperative stress response.\" This study aimed to evaluate the relationship between hemogram-derived inflammatory markers and the development of preoperative anxiety and EA in pediatric patients.</p><p><strong>Methods: </strong>This prospective observational study included 350 pediatric patients aged 5-12 years with ASA grade I-II. Preoperative anxiety was assessed in the waiting room using the modified Yale Preoperative Anxiety Scale. Demographic and clinical data, anesthesia/surgical data, and hemogram parameters were recorded. EA was evaluated in the recovery room using the Pediatric Anesthesia Emergence Delirium scale. Pain was assessed at 0, 5, 10, 20, and 30 min using the FLACC scale in children < 7 years and the Visual Analog Scale in those ≥ 7 years.</p><p><strong>Results: </strong>Of the total 350 patients, 130 (37.1%) developed EA. Compared with those without EA, children with EA had significantly higher leukocyte, monocyte, neutrophil, and platelet counts (p = 0.018, 0.005, 0.001, and 0.001, respectively), lower lymphocyte counts (p = 0.042), and elevated monocyte-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic immune inflammatory index (SII) (all p < 0.001). Regression analysis showed that younger age, higher postoperative pain scores, and elevated SII were independently associated with EA. Preoperative anxiety was observed in 103 children (29.4%). These patients had higher white blood cell counts (p = 0.026), and regression analysis identified that younger age, anxious parents, and elevated SII were independently associated with preoperative anxiety.</p><p><strong>Conclusion: </strong>Easily obtainable hemogram-derived inflammatory markers, particularly SII, may be useful for identifying children at increased risk of preoperative anxiety and EA in children. These findings suggest that SII may assist anesthesiologists in identifying high-risk patients and implementing preventive strategies to reduce the incidence of EA.</p><p><strong>Trial registration: </strong>The study was registered at ClinicalTrials.gov (NCT06648122).</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1132-1142"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148271619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychometric Evaluation of the Turkish Version of the Induction Compliance Checklist in Children Undergoing Mask Anesthesia.","authors":"Faruk Cicekci","doi":"10.1002/pan.70299","DOIUrl":"https://doi.org/10.1002/pan.70299","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Esketamine for Pediatric Emergence Delirium: Is the Evidence Conclusive?","authors":"Tuhin Mistry, Abhijit Sukumaran Nair","doi":"10.1002/pan.70298","DOIUrl":"https://doi.org/10.1002/pan.70298","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Routine Videolaryngoscopy in Neonates: Implementation Should Include a Training Curriculum.","authors":"Weerapong Lilitwat","doi":"10.1002/pan.70296","DOIUrl":"https://doi.org/10.1002/pan.70296","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Meeting Trainees Where They Are: Rethinking Fellowship Pipeline Development in Anesthesiology.","authors":"Philip Carullo, Sabina Khan, Ariana Abdollahnejad, Erin Conner, Mitchell Phillips, Kevin Spellman, Allison Thoeny, Tammy Wang, Rebecca Nause-Osthoff","doi":"10.1002/pan.70297","DOIUrl":"https://doi.org/10.1002/pan.70297","url":null,"abstract":"<p><strong>Background: </strong>Anesthesiology continues to attract growing interest among medical school graduates, yet its subspecialty fellowships remain chronically underfilled. Pediatric anesthesiology illustrates the pattern clearly, with unfilled fellowship positions rising more than fivefold between 2017 and 2023. Compensation is often cited as a driver but does not appear to fully explain the trend.</p><p><strong>Aims: </strong>This Perspective examines when subspecialty interest actually develops and argues that the traditional assumption that it forms during residency may already be too late.</p><p><strong>Findings: </strong>National Academies data indicate that a substantial share of pediatric subspecialists chose their field at the start of medical school, well before meaningful clinical exposure. A national survey of anesthesiology residents found that many enter their fellowship decision year without a subspecialty direction, and that adequate exposure during pediatric rotations was among the strongest predictors of fellowship pursuit, though such exposure varies widely by program. National efforts, including the Society for Pediatric Anesthesia's SPAERS committee and the Minds on Peds platform launching in early 2027, aim to standardize exposure earlier in training, in part through social media outreach to preclinical students. Fellowship fill rates have improved over this period of expanded outreach, although direct evidence linking social media exposure to subspecialty interest is still lacking.</p><p><strong>Conclusions: </strong>Residency-level interventions alone are unlikely to resolve the fellowship pipeline problem. The field should extend and standardize subspecialty exposure into the medical school years and build a deliberate, authentic presence on the platforms where trainees already learn.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}